<B>Hodgkin's Disease, Nodular Sclerosing Type </B>

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Hodgkin's Disease, Nodular Sclerosing Type

Etiology:

• Unknown

Pathogenesis:

• Relatively small population of neoplastic cells which include classic Reed Sternberg cell as well as mononuclear variant, lacunar cells
• Marked inflammatory reaction driven by cytokines secreted by neoplastic cells including IL 5 (attracting eosinophils), IL4, tumor necrosis factor alpha, GM-CSF
• TNF beta associated with fibrosis

Epidemiology:

• 0.7% of all new cancers in the U.S. overall for Hodgkin's disease
• Average age 32 years
• Only variant more common in women
• Often presents in mediastinum
• One of most common varieties

General Gross Description:

• Enlarged, firm, fleshy lymph node with irregular nodules separated by bands of firmer, fibrotic tissue

General Microscopic Description:

• Sclerosis, in broad bands of birefringent collagen
• Lacunar cells with nuclei containing lacy chromatin, small to medium sized nucleoli, and polylobation; cytoplasm may be clear or palely eosinophilic
• Pale areas around cells on formalin fixation
• Mark with CD30 (Ki-1) and CD15 (Leu M-1); do not mark with CD45 (LCA)
• Reed Sternberg cells are classic binucleate cells with prominent macronucleoli which are eosinophilic (owl eye)

Clinical Correlations:

• Spreads sequentially along nodal groups
• Responsive to locoregional treatment with radiation
• Excellent prognosis

References:
• Jaffe ES, Surgical Pathology of the Lymph Nodes and related organs, second edition, W.B. Saunders; Philadelphia, 1995, pp..151-166.